Provider Demographics
NPI:1699962464
Name:KJELL A. YOUNGREN, M.D., P.C.
Entity type:Organization
Organization Name:KJELL A. YOUNGREN, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KJELL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:YOUNGREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-889-0049
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-0600
Mailing Address - Country:US
Mailing Address - Phone:973-889-0049
Mailing Address - Fax:973-889-0043
Practice Address - Street 1:290 MADISON AVE
Practice Address - Street 2:BLDG. 5
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7400
Practice Address - Country:US
Practice Address - Phone:973-889-0049
Practice Address - Fax:973-889-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06467700208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ089756Medicare PIN